GWP - Strategy Thread

gioborla: Thank you for the articles. Having read through the interview with Lester Grinspoon, M.D., I have to admit to being a little annoyed. Some of the points he makes are valid, some are not, not surprisingly all are twisted to suit his argument.

My response is long, for which I apologise, but I am not able to flout such credentials as being an M.D. or associate professor emeritus of psychiatry at Harvard Medical School so it takes longer for me to formulate a response against such a learned writer; especially from someone whose background suggests that he should be authorative on the subject.

A quick google of "Lester Grinspoon" reveals that he's strongly in favour of legalising the smoking cannabis in any form and will write for just about anyone that is prepared to print his articles including such variety as the Journal of Drug Policy and Playboy (where I'm sure there are at least a couple of interesting points...) and he has been quoted, although not published in, the BMJ.

I'm going to respond to the article with quotes of passages shown in italics from the original text at

Lester Grinspoon: ...Geoffrey Guy went to the home office and said in effect, “Look, everybody knows that cannabis has medicinal utilities,” and the British government, just like the U.S. government, was being pressed to do something about it. He then said, “I have the plans for a product which will deliver all the medical capacities of cannabis, but at the same time not impose on the medical user the two most frightful things about cannabis -- the high and the pulmonary effect.” To me, that was based on a deception because we know now that the pulmonary problems are minimal.

We do not know that the pulmonary (inhaling cannabis into the lungs) problems are minimal. Cannabis, of which there are four main strains, contain over 200 chemicals. When it is smoked there are carcinogens (chemicals that may cause cancer to people genetically predisposed). Recent research has suggested, not proved, that the carcinogenic effect is less than smoking tobacco due to some of the other chemicals in cannabis negating the effect.

As for the high, I don’t believe that the high is a big problem in people with Crohn's Disease or Multiple Sclerosis, who feel better when they smoke cannabis—that’s probably a function of the anti-depressant effect of this substance. What’s the problem with that?

The problem is that you don't know which chemicals are having the anti-depressant effect and what other side-effect these chemicals might have. This is the whole purpose of scientifically approving a known and replicable chemical and potency.

If after administering Sativex the patient is then able to lead a normal life they will not want to be on a high. A high has an incapacitive effect on people - they are unable to think clearly and may be unaware that this is the case. How would your employer feel if you turned up to work drunk because you thought that it made you feel better able to cope?

Well, if you can get relief from the spasticity without getting a high, then you could do the same with the smoked stuff.

No you could not. The "smoked stuff" will vary in strength, from sample to sample, and be dependent on the amount inhaled - not an exact science. A spray of Sativex delivers between 2.5 and 2.7 mg.

It’s much easier to titrate when you’re using the pulmonary system than when you’re using the sublingual [under the tongue] or oral system.... You take it sublingually, it’s maybe 15 minutes... But it’s nowhere near as fast as smoking it. That to me is one of the great advantages of smoking cannabis -- that the patient can have control. He can get just the right amount for his symptoms. You are not going be able to titrate it for a while if it’s going to take you 15-20 minutes to get an effect.

True that the pulmonary system is faster to titrate, but it has to be every time because the dosage varies. The patient does not have control, they think they do. Once the titration has been done for Sativex you can guarantee that the same number of sprays will be the same dosage the next day. It's important to remember that we are talking about a palliative drug, we want the patients to continue as close to normal lives as possible.

LG: Better and faster. And there’s another reason. The sublingual route was the idea with GW Pharmaceuticals, but the fact of the matter is you can’t hold it under the tongue very long.

GG: Is that because preparation stings or…?

LG: It has a dreadful taste.

I'd hope that a doctor (oh, he's a psychiatrist) would know that the tastebuds are on the top of the tongue. Sure, some of the spray may miss the sublingual area but isn't that an indication that you're not applying it correctly - Ratsnaks, could you comment on this please?

They then discuss the fact that you don't want Sativex absorbed through the gastrointestinal tract, which I'd absolutely agree with.

Now the other thing GW Pharmaceuticals claims is that people can’t get high—that’s absolutely untrue.

GG: Yeah, they’re actually backing off of that claim.

GW have never, to my knowledge, said that you can't get high on Sativex. What they have said is that the palliative window which patients are aiming for falls short of the amount that is needed to get high.

LG: .... Sativex may go the same way [as Marinol] because I would challenge Sativex to compete against smoked marijuana in almost every one of the symptoms or syndromes …

GG: It doesn’t appear that they’re doing that.

LG: They’re absolutely not. They’re not running it against smoked marijuana. I think those results in Multiple Sclerosis would have been much better if those people had been allowed to use smoked marijuana.

That may be true one day, but not the next. We're back to the problem that you can't vary the dosage and substance and have a hope in hell of getting through an approval process. The approval process is not just a hurdle that drugs companies have to get over. It's a method that allows a safety and efficacy framework around taking a drug. If the drug doesn't work or it's dangerous it provides a paper trail to the cause.

GG: So really the medical issue is inseparable from the legalization issue?

LG: Exactly. You can’t say, “Okay, marijuana is medicine that’s going be distributed by pharmacies,” because it simply won’t work. People will have all sorts of fictitious ailments, and doctors don’t want to be the gatekeepers. It’s basically what’s going on in California. If you want to look for a place where you can prove that that model isn’t going work, it’s California. I had lunch with a woman the other day from California. She’s a high powered academic and she uses cannabis, and I asked her where she gets it, and is it easy to get in California? She took out of her wallet a card for a buyer’s club an says, “This is how.” I said, “What are you suffering from?” She said, “Well, I’m a little depressed.” Or something like that. She winked. That’s exactly what would happen if we tried to do it that way.

The crux of this argument is that there are some that will be unable to distinguish the use of cannabis for medicinal and recreational reasons. It's no wonder that Geoffrey Guy tries to distance himself from them. There will always be people prepared to take the latest drugs for recreational use. As long as there are mood altering drugs like ecstacy, coccaine, cannabis etc. exist there will be people prepared to take them.

I think the article makes it clear that there are people trying to legalise cannabis and are trying to have it both ways. They worry that the effect of Sativex appearing will make it less likely that the prohibition on cannabis will be removed, yet they hope that its approval will retrospectively give scientific proof to the medicinal uses of cannabis which will strengthen their argument for legalising it.

Oh, and the doctor tells a fine anecdote.

CFB